Yellowknife Tuberculosis Outbreak 2007

919 views

Published on

Review of the Genesis of the Yellowknife Tuberculosis Outbreak 2007

Ewan Affleck
Medical Director YHSSA

Circumpolar Rounds
Stanton Territorial Hospital
Yellowknife, NT
January 7, 2010
http://ichr.ca

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
919
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Yellowknife Tuberculosis Outbreak 2007

  1. 1. REVIEW  OF  THE  GENESIS     OF  THE     YELLOWKNIFE  TUBERCULOSIS   OUTBREAK  2007   Ewan  Affleck   Medical  Director  YHSSA     Director  of  Family  Medicine  STHA   ICHR  –  Yellowknife,  July  2009  
  2. 2. TB  OUTBREAK  IN  YELLOWKNIFE  -­‐  2007   •  Index  case  sought  medical  attention  7  months  before  positive   identification.   •  Diagnosed  with  highly  infectious  strain  of  TB.     •  Index  case  has  contact  with  over  700  people.   •  16  cases  of  active  TB  resulted  from  this  outbreak.       •  Significant  upfront  and  long-­‐term  costs  to  the  health  care   system.   •  Subsequent  changes  made  /  snapshot  from  2007  
  3. 3. Research  Project   •  Team:      Brenda  Kolasa  –  PH  Nurse,  Candy  Grimm  –  NP,    Cherie  Shae   –  NP,  Christine  Scott  –MD,  Dave  Pontin  –  MD,  Ewan  Affleck  –   Medical  Director  &  Project  Lead,  Jo-­‐Anne  Hubert  –  Director   of  NP  Program,  Lorrie  Parton  –  Director  of  PH  YHSSA,  Ruth   Robertson  –  CEO  YHSSA   •  Method:  Tracer  Methodology  –  2  cases  (2007  &  2003)   •  Context:    Fanning  Reports  of  2001  &  2006  
  4. 4. Deputy   Minister  of   Health   Chief  Medical   Health  Officer   Population  Health   TB  statistics  /  Nursing  station  support   Stanton  Territorial   Health  Authority   Other   Yellowknife  Health   Health   &  Social  Services   Authorities   Authority  (YHSSA)   BDHSSA   Regional   0.2  FTE   Environmental   Medical   Health   MHO   Primary   YHSSA   Health   health  care   Public   Officer   workers   Health  Unit  
  5. 5. WHO  PROVIDED  THE  CARE   TO  THE  INDEX  CASE?   3  clinic  based  physicians   2  radiologists   3  hospitalists   1  Medical  health  officer   1  Public  health  nurse   1  ER  physician   1  Nurse  Practitioner   1  Otolaryngologist   ___________________   TOTAL:    13  HEALTH  CARE   PROFESSIONALS  
  6. 6. Chief  Medical   Health  Officer   Population  Health   TB  statistics  /  Nursing  station  support   Stanton  Territorial   Health  Authority   Other   Yellowknife  Health   Health   &  Social  Services   Authorities   Authority  (YHSSA)   BDHSSA   Regional   0.2  FTE   Primary   Environmental   Medical   Health   MHO   health  care   YHSSA   Health   workers   Public   Officer   Health  Unit   Index   Case  
  7. 7. Chief  Medical   Health  Officer   Population  Health   TB  statistics  /  Nursing  station  support   Stanton  Territorial   Yellowknife  Health   Health  Authority   &  Social  Services   Authority  (YHSSA)   Regional   Medical   Primary   YHSSA   Health   health  care   Public   Officer   workers   Health  Unit   Index   Case  
  8. 8. What  Happened?   OPERATIONAL   GOVERNANCE   •  Everyone  involved  acted   •  Structural  obstacles   upon  the  information  they   •  Cultural  obstacles   had   •  Lack  of  integration   •  Cognitive  bias   •  Lack  of  system  wide   •  Multiple  errors  of   standards   assumption  /   •  Lack  of  accountability   communication   •  Coordination   •  Lack  of  standards  and  set   roles  &  responsibilities.  
  9. 9. Findings  of  Naylor  Report   •  Lack  of  surge  capacity  in  the  clinical  and  public  health  systems   •  “Dysfunctional”  relationships  between  various  orders  of  governments  and   ill-­‐  coordinated  responses  to  SARS   •  Absence  of  protocols  for  data  or  information  sharing  among  levels  of   government  and  uncertainties  about  data  ownership   •  Lack  of  coordinated  business  processes  across  institutions   •  Inadequacies  in  institutional  outbreak  management  protocols   •  Weak  links  between  public  health  and  personal  health  services  including   primary  care,  institutions  and  home  care  
  10. 10. Conclusion   “From  Research  to  Action”   •  Governance   •  Standards   •  Accountability   •  Relationships  
  11. 11. Questions?  

×